In-hospital mortality after pancreatoduodenectomy reveals critical timing for interventions impacting patient outcomes.

• 3.5% of patients (156 of 4474) died in the hospital, primarily from three complication clusters: postpancreatectomy-specific (51.9%), vascular (25.6%), and cardiopulmonary (17.9%).
• Complications emerge at different postoperative intervals: median 9 days for postpancreatectomy, 4.5 days for vascular, and 3 days for cardiopulmonary issues.

Timing matters—intervene sooner for vascular and cardiopulmonary issues to improve survival rates.

• After postpancreatectomy complications, the median time to death was 31 days; for vascular issues, it was 18 days, and for cardiopulmonary, just 1 day.